SADA-14 WHEN COMPLICATIONS MATTER: THE IMPACT OF POSTOPERATIVE ADVERSE EVENTS ON SURVIVAL AND QUALITY OF LIFE IN METASTATIC SPINE DISEASE
Andrew Hardigan, Giovanni Barbanti Brodano, Christina Griffoni, Francesca Salamanna, Luigi Emanuele Noli, Annalisa Monetta, Alexander Disch, Aron Lazary, Ziya L Gokaslan, Michael G Fehlings, Jorrit-Jan Verlaan, Dean Chou, Laurence Rhines, John Shin, William G J Teixeira, Daniel M Sciubba, Chetan Bettegowda, Raphaële Charest-Morin, Stefano Boriani, Tony Goldschlager, Michael H Weber, Michelle J Clarke, John E O’Toole, Cordula Netzer, Addisu Mesfin, Praveen V Mummaneni, Nicholas Dea, Jeremy Reynolds, Arjun Sahgal, Charles Fisher, Alessandro Gasbarrini, , C Rory GoodwinAbstract
Introduction
As the incidence of metastatic spine disease (MSD) increases, treatments to manage refractory pain, pathologic vertebral body fractures, and spinal cord compression are becoming increasingly common. Given the palliative nature of surgical intervention used to achieve tumor control and thus mitigate loss of neurologic function and compromised ambulatory function, it is essential to mitigate the risk of such procedures.
Methods
The AO Spine Knowledge Forum Tumor’s Metastatic Tumor Research and Outcomes Network (MTRON), an international, prospective registry for patients with spinal metastases, was used for this query. Prospective collection included baseline health and demographic information, oncologic data (including Spinal Instability Neoplastic Score (SINS) score and Bilksy epidural compression classification), and baseline functional status (preoperative American Spinal Injury Association (ASIA) and ECOG scores). Health related quality of life (HRQoL) data included Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) and Euro-QoL measures. Surgery related adverse events (AE’s) were collected using the Spine Adverse Events Severity (SAVES V2) framework. Kaplan-Meir curves were used to assess survival.
Results
The cohort consisted of 1267 patients, 701 male (55.3%). A total of 245 (19.3%) experienced at least one postoperative AE, the majority of which were considered minor (grade 3 or less). Among the most common were deep wound infections (3.2%), wound dehiscence (2.5%), and urinary infections (2.4%). A multivariate analysis demonstrated that age, smoking status, ECOG performance, prior radiotherapy, presence of multiple metastases at other sites, and multiple spine metastases were significant risk factors for a postoperative AE. Postoperative AE’s (p = 0.049) and major postoperative AE’s (p = 0.0038) were found to be related to survival as well as a significant change in HRQoL scores (p < 0.001).
Conclusion
Postoperative AE’s are extremely relevant to the care of patients with MSD and impact both HRQoL and survival.